What Is All On 4 Dental Implants

If you’re considering dental implants, you may have heard about the revolutionary All On 4 concept. This innovative approach to implant dentistry offers a solution for patients with severely atrophic jaws, making it an excellent alternative to traditional implant applications. In this article, we’ll delve into the details of the All On 4 concept, its advantages, and the treatment protocol involved.

What Is All On 4 Dental Implants
What Is All On 4 Dental Implants

The History of All On 4 Concept

The concept of All On 4 dental implants was first introduced by Mattson and colleagues in 1999. They successfully treated patients with severely resorbed edentulous maxilla by inserting 4 to 6 implants in the premaxilla region. Later, in 2000, Krekmanov and colleagues demonstrated the possibility of posterior tilted implant-supported prostheses. However, it was in 2003 that Paulo Malo and his colleagues developed, institutionalized, and systematically analyzed the All On 4 immediate loading concept.

Advantages of All On 4 Concept

The All On 4 concept offers numerous benefits over traditional implant methods. Firstly, it avoids complex surgery, making it a less invasive and graft-less procedure. The implants are strategically spaced, ensuring good biomechanics and easy cleaning. Patients can enjoy immediate function and improved aesthetics. The All On 4 concept also simplifies both surgical and prosthetic procedures, leading to reduced costs due to the use of fewer implants. Moreover, it boasts high success rates and allows for the placement of angled posterior implants to avoid anatomical structures. This enables longer implants to be anchored in better-quality bone and reduces posterior cantilever.

Considerations for All On 4 Cases

When it comes to All On 4 procedures, there are several important considerations to keep in mind. The primary concern is achieving the initial or primary stability of the implants, ranging from a minimum of 35Ncm to a maximum of 45Ncm. Additionally, there should be a minimum of 5mm of bone width and a minimum of 10mm of bone height available in the implant placement site. Splinting of tilted implants can be done if the angulation exceeds 30 degrees. In the case of tilted implants in the posterior edentulous region, the access hole to the distal screw should be located at the occlusal face of the first molar, second premolar, and the first premolar.

Treatment Protocol for All On 4 Cases

The treatment protocol for All On 4 cases consists of two phases: surgical and prosthetic. Let’s go through each phase in detail.

Surgical Phase

In the surgical phase, a guide is used to plan the implant placement. The titanium band is contoured to follow the arc of the opposing arch, and the vertical lines on the guide serve as a drilling guide. The two anteriormost implants are oriented in the same direction as the jaw anatomy, while the two posterior implants are tilted distally 30┬░-45┬░ relative to the occlusal plane. Implant torque is set to greater than 35 Ncm to ensure stability.

Prosthetic Phase

In the prosthetic phase, multiunit abutments and angulated abutments are placed onto the implants. For provisional prosthesis fabrication on the day of surgery, impression copings are used and splinted with autopolymerizing resin and wire bars. This ensures an accurate transfer without displacement. A final prosthesis is fabricated 4-6 months after the initial implant placement, using CAD/CAM technology for the framework. The final prosthesis can be metal-acrylic resin, metal-ceramic, or all-ceramic zirconia crowns.

Conclusion

The All On 4 concept has revolutionized implant dentistry, offering a viable solution for patients with severely atrophic jaws. Its advantages include a less invasive procedure, improved aesthetics, simplified surgical and prosthetic procedures, and high success rates. By following the treatment protocol, patients can achieve stable and functional results. If you’re considering dental implants, the All On 4 concept may be the answer you’ve been looking for.

All On 4 Dental Implants

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